30B-093 (9) BP-2022-0138
60 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-093-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0138 PERMISSIONIS HEREBY GRANTED TO:
Project# 2022 ADDITION Contractor: License:
Est.Cost: 303000 TIMOTHY STOKES CS083602
Const.Class: Exp.Date:02/06/2023
Use Group: Owner: WHITMAN STIFLER REYN
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: TIMOTHY STOKES
Applicant Address Phone: Insurance:
20 TURKEY HILL RD (413)695-2264 , SOLE PROPRIETOR
WESTHAMPTON, MA 01027
ISSUED ON:03/04/2022
TO PERFORM THE FOLLOWING WORK:
2ND STORY ADDITION TO 1 STORY HOUSE, PARTIAL RE-ORGANIZATION OF EXISTING 1ST FLOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House # Foundation:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: i5ri
)2
Fees Paid: $1,970.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
- . (yo LA,s0 r ii,AIS
1
,�;� The Commonwealth of Massachusetts Z—G
"' Board of Building Regulations and Standards FOR
jJ
Massachusetts State Building Code, 780 CMR MUNICIPALITY
SE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
I �,r One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: Bp-20 ZZ-013g Date Applied: 0211 l/ZO2.z
' c:uir-3 ` orig___ 3-1-4-ZOzZ
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 property Address:re ��- 1.2 Assessorsso Map& Parcel Numbers
6.1.1 a Is thisthiaccepted e str t om?b no Map ) be Parcel Number 00 i
Y
1.3 Zoni Information: 1.4 Property Dimensions:
iit-t34vm 82
Zoning strict Proposed Use Lot Area(sq ft)ZQ)/iO3]/ Frontage(ft)
1.5 Building Setbacks(ft) �Tq
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
if0 ' II , t s ' 16 I 2- 0 zOd
1.6 Water Supply: L C. 0,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private 0 Zone: _ Outside Flood Zone?Check if yes❑ a .�,Municipal ) On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
T2 r( w i 11 vv, Late, a 166 0
Name(Print) City, tate,ZIP
0 tsl9, t� � � Act-44- -0-110 rusyrt wx ri-nkr1 ) cavil-\ (,,co+M
o.and Street Telephone I mail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)A Addition Jg
Demolition ❑ Accessory Bldg.❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
- )
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ �/-1(� 1. Building Permit Fee: $ Indicate how fee is determined:
1000 — 0 Standard City/Town Application Fee
2.Electrical $ 74 IOW 0 Total Project Cost3(Item 6)x multiplier (o; x j 0 3
3. Plumbing $ /3�00O 2, Other Fees: $
4.Mechanical (HVAC) $ 2ti 1 en d List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ tvo '= v o
6.Total Project Cost: $ Check No.(�g(/Check Amount:41/g70,-'
3'06 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts 4e.
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building;. nb`'
Northampton, MA 01060 frkV.
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new/replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) D360 Z
t
o�.s�
yvkp License Number E pir ion Date
Name of CSL H, der
( � ix,..7 �wL � List CSL Type(see below)
No.and Street r e Description
v v i f Unrestricted(Buildings up to 35,000 Cu.ft.)
�� Restricted 1&2 Family Dwelling
City/Town,State, t M Masonry
6 1,4 271 RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
a 13•-Cat 5"Z7 f 7 t0 J LQt ��iljNldjLO• I Insulation
Telephone Email address GOlAn D Demolition
5.2—Registered Home Improvement Contractor(HIC) 1�...� Sq Z, S ..2,1--Finn 6 �191G[�3 HIC Registration Number E irati n Date
HIC Company Namptor HIC egistrant Name
No.and Street / Email address
W tt oo - 1.1 ,1 4g Z
S Z61
City/Town,State,ZIP ( Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes No . 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize -VI M $l-0v-e5
to act on my behalf,in all matters relative to work
n authorized by this building permit application.
VkikC 0.r VA - 1 / z / 27__
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under ins and penalties of perjury that all of the information
con
in this application is true and a to to the best of my knowledge and understanding.
w\ e, / 3d Z 2,Print Owner's or Authorized Agent's Name me ignature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work i planned,provide the information below:
Total floor area(sq. ft.) / r . (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) /3 CO Habitable room count 7
Number of fireplaces / Number of bedrooms Z
Number of bathrooms 2-- Number of half/baths
Type of heating system )f w►P Number of decks/porches .-
Type of cooling system F b po Ai 0 Enclosed ` Open /
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
z The Commonwealth of Massachusetts
Department of Industrial Accidents
/ Congress Street,Suite 100
Boston, 31,4 02114-2017
... .`,.,/, WWW„mass.govidia
%%Otters' ('ompensation Insurance Affidavit: Builders/ContraetorsfElectritiatuttPlunsbers.
TO at:FILED WITH THE PER AI 11-EING AUTHORITY.
Applicant Information Please Print Legiblv
Name(Business,OrpoirationAndividual):
Address: -2.c.:, 'T---o-V/Att 44 WC, BO
5
City/State/Zip:AL063 Phone #: 4 1 3 61Z
cpifti
Are yea m eamilimes1(lick the appropriate bus: Type of project(required):
1.0 1 ancr t a eiplioyoc with ,enicloyees ithil sedkrr pati rt, me I.*
: 7. 0 New construction
2;xi I am a sok proprietor or partnership and have no eamkryeet working for Vibe in ' 3../E1 Remodeling
capacity.(No*eaters'comp.insuranix required.)
9. 0 Demolition
30 I am a homeowner doing all work myself,[No workers"comp,insuranec restminsij' [ 1 I pi, Building addition
salmi a homeowner and will he hiring contractors so cooduet all week on my progerty. 1 will
moire that all COntracium either have KAkikeTh'earlpetiaatiaxt insurance ax art auk I 43 Electrical repairs or additions
proprietors with no employees,
12.0 Plumbing repairs or additions
5c3 I am a general contractor and I have hired the sub-contracionk listed on the attached sheet
These sub-contiactors have employers and have workers'comp.traatrarier i 3.0 Roof repairs.
60 We are a corporation and its officers have exercised them right of exemption per kkil e, 14.0 Other
152,*1(4),and we have no arnployees.[No siestas'comp,insiarance required.]
0Asy applicant that cheeks box#1 must also fill out the section below shwa tng their+initial'compensation policy information,
t Morn who submit this affidavit iiwhcairng they are doing all work and then hire outside contractors must submit a new affidavit indicating sUck
;Contractors that check this brim mug attached an additional sheet shostong the none of the sulventritractors and state whether in not those entities haw
employee, It the sub-contrJLtots haw employees,they must provide their workers' ..xnnp.piney number,
I am an employer that is providing workers"compensation insurance Or my employees. Below is the policy and jab rite
information.
Insioark:c t'orripany Name:
Poll: ,!:or Self-ins. Lie.tt: Expiration Date:
Job Site Address: City/Stateitip: _ _____.
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500..00
anctior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.(X0 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cerrili•u I t' oins and penalties of perjury that the information provided abase is ue and correct.
Signature. I)atc -_;
Phone g: A 3 c9
Official use only. Do not write in this area,to be completed by city or town official. I
:,. tit, or'Town: Permit,Ticense 4
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.t'its!Tow n Clerk 4. Electrical Inspector 5. Plumbing Inspector
: 6.Other
Contact Person: Phone 4:
City of Northampton
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Massachusetts �.r�
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
9aArc
Northampton, MA 01060 ••- j'�
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility:
The debris will be transported by:
Name of Hauler: -AV")-k 1n,\jC.
Signature of Applicant. ,,4 Date: (/ /LTi
City of Northampton
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Massachusetts ` ''.��
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*, DEPARTMENT OF BUILDING INSPECTIONS aA
212 Main Street • Municipal Building 0% -�;b
' Northampton, MA 01060 ^^
G . 5
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, _ (insert full legal name), born (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State. Building Code's requirements for the supervision of
the project or work on my parcel, 1 am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision'of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20 .
(Signature)